<div class="form_section"><h1>1. Personal Information</h1></div>
First Name: <input type="text" name="fname" id="fname" /><br />
Last Name: <input type="text" name="lname" id="lname" /><br />
<div class="form_section"><h1>2. Academic Information</h1></div>
University Affliation:
<select name="univ_aff" id="univ_aff">
<option name="default" id="default">Select One</option>
<option name="upd" id="upd">University of the Philippines-Diliman</option>
</select><br />
Department Affliation:
<select name="dept_aff" id="dept_aff" disabled="disabled">
<option name="default" id="default">Select One</option>
<option name="dcs" id="dcs">Department of Computer Science</option>
</select>
<div class="form_section"><h1>3. Account Information</h1></div>
Log-in ID: <input type="text" name="uname" id="uname" /><br />
Password: <input type="password" name="pword" id="pword" /><br />
Re-type Password: <input type="password" /><br />
<br />
<input type="submit" value="Register" />